Provider Demographics
NPI:1689393324
Name:AMMANN, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:AMMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LUCILLE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1022
Mailing Address - Country:US
Mailing Address - Phone:631-721-5616
Mailing Address - Fax:
Practice Address - Street 1:35 LUCILLE DR
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1022
Practice Address - Country:US
Practice Address - Phone:631-721-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2818658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist